<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0">
    <meta name="description" content="">
    <meta name="author" content="">
    <title>发票申请</title>
    <include file="Template/head"/>
<body>
<div class="actNav">
    <div class="doRefresh">发票申请</div>
    <a href="javascript:history.go(-1);" class="back"></a>
    <a href="{:U('Index/index')}" class="home"></a>
</div>
<div class="wapper">
    <form method="post" action="" id="signupForm" class="zcform">
        <input id="applyInvoice" type="hidden" value="{:U('Finance/applyInvoice')}"/>
        <input id="invoiceList" type="hidden" value="{:U('Finance/index')}"/>
        <input type="hidden" id="code" value="{$Think.session.applyInvoice}">

        <div class="fpApply">
            <label class="t">发票抬头</label>

            <div class="input-group">
                <span class="input-group-addon">公司名称</span>
                <input type="text" class="form-control" name="title" id="title"/>
            </div>
            <label class="t">发票项目</label>

            <div class="input-group">
                <span class="input-group-addon">请选择发票项目</span>
                <select class="form-control" name="detail" id="detail">
                    <foreach name="invoiceTypeList" item="vo">
                        <option value="{$vo.detail}">{$vo.detail}</option>
                    </foreach>

                </select>
            </div>
            <label class="t">剩余发票额度: <span style="color: #f08519;">{$lastTotal|getYuan}</span></label>

            <div class="input-group">

            </div>
            <label class="t">发票金额</label>

            <div class="input-group">
                <span class="input-group-addon">请输入发票金额</span>
                <input type="number" class="form-control" name="amount" id="amount"/>
            </div>
            <label class="t">索取方式</label>

            <div class="input-group clearfix">
                <div class="radio">
                    <label>
                        <input type="radio" name="request_method" value="2" checked data-num="1" autocomplete="off">
                        快递
                    </label>
                </div>
                <div class="radio r-2">
                    <label>
                        <input type="radio" name="request_method" value="1" data-num="2" autocomplete="off">
                        自取
                    </label>
                </div>
            </div>
            <div id="kd">
                <label class="t">快递选择</label>

                <div class="input-group clearfix">
                    <div class="radio">
                        <label>
                            <input type="radio" name="express_fee" value="3" checked data-num="3" autocomplete="off">
                            到付 (货到付款)
                        </label>
                    </div>
                    <div class="radio r-2">
                        <label>
                            <input type="radio" name="express_fee" value="4" data-num="4" autocomplete="off">
                            邮寄 (支付{$invoiceFeeInfo.express_fee|GetYuanWhole}元快递费用)
                        </label>
                    </div>
                </div>
                <div class="item-group clearfix">
                    <label class="t">邮寄地址</label>
                    <textarea class="form-control" id="addr" name="addr" rows="3" placeholder="请输入邮寄地址"></textarea>
                </div>
                <div class="item-group clearfix">
                    <label class="t">联&nbsp;系&nbsp;人</label>
                    <input type="text" class="form-control" id="name" name="name" placeholder="请输入联系人">
                </div>
                <div class="item-group clearfix">
                    <label class="t">联系电话</label>
                    <input type="number" class="form-control" id="phone" name="phone" placeholder="请输入手机号">
                </div>
                <div class="item-group clearfix">
                    <label class="t">备注</label>
                    <input type="text" class="form-control" id="remark" name="remark" placeholder="请输入备注信息">
                </div>
            </div>
            <div id="zq" style="display:none;">
                <div class="item-group clearfix">
                    <label class="t">公司地址</label>
                    <input type="text" class="form-control" value="{$address}" disabled>
                </div>
                <div class="item-group clearfix">
                    <label class="t">联系电话</label>
                    <input type="text" class="form-control" value="{$tel}" disabled>
                </div>
            </div>
            <div class="pad"><input type="button" id="doSubmitApplyInvoice"
                                    class="btn btn-primary btn-lg btn-block proofAgain" value="提交申请"/></div>
        </div>
    </form>

    <div class="modal fade popWin bs-example-modal-sm" id="myModalDel" tabindex="-1" role="dialog"
         aria-labelledby="myModalLabel" aria-hidden="true">
        <div class="modal-dialog modal-sm">
            <div class="modal-content">
                <div class="modal-header">
                    <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span
                            aria-hidden="true">&times;</span></button>
                    <h4 class="modal-title" id="myModalLabel">提示</h4>
                </div>
                <div class="modal-body text-center">
                    <p class="tipsBox"><i class="warn"></i>请将信息填写完整</p>
                </div>
                <div class="modal-footer">
                    <button type="button" class="btn btn-warning doSubmit" data-dismiss="modal" aria-label="Close">确认</button>
                    <button type="button" class="btn btn-default doCancel" data-dismiss="modal" aria-label="Close">取消</button>
                </div>
            </div>
        </div>
    </div>

    <div class="modal fade popWin bs-example-modal-sm" id="myModalSuc" tabindex="-1" role="dialog"
         aria-labelledby="myModalLabel" aria-hidden="true">
        <div class="modal-dialog modal-sm">
            <div class="modal-content">
                <div class="modal-header">
                    <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span
                            aria-hidden="true">&times;</span></button>
                    <h4 class="modal-title" id="myModalLabel">提示</h4>
                </div>
                <div class="modal-body text-center">
                    <p class="tipsBox"><i class="suc"></i>申请成功</p>
                </div>
                <div class="modal-footer">
                    <button type="button" class="btn btn-warning doSubmitApplyInvoice doSubmit" data-dismiss="modal"
                            aria-label="Close">确认
                    </button>
                    <button type="button" class="btn btn-default doCancel" data-dismiss="modal" aria-label="Close">取消</button>
                </div>
            </div>
        </div>
    </div>
    <footer class="footer">
        <include file="Template/foot"/>
    </footer>
</div>

</body>
</html>
